3 April, 2002

Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 1

Qualitative Research Methods DATA GATHERING &

DATA ANALYSIS

David R. ThomasHealth Research Methods Advisory Service

Department of Community HealthUniversity of Auckland

What are qualitative data?

Data in the form of words, language in the form of extended textShort text (e.g., interview and questionnaire responses < one page)Long text (e.g., interview responses > one page)Observations of settings and events (e.g., researcher’s notes)

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Selecting research methods

Underlying values and

assumptions

Research purposes and

strategies

Data gathering procedures

Data analysis procedures

Types of data presentation

Purposes for collecting qualitative data - 1

When only a few cases or events are available (e.g., new communicable diseases, accidents)Event cannot be easily reproduced (or is very costly to reproduce)The health problem has complexities which are not clearly understood

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 3

Purposes for collecting qualitative data - 2

To understand context, processes & events in everyday settingsPreliminary investigation of topic with little previous research No trustworthy measures availableAssess validity of quantitative methods

Qualitative research approaches or traditions

PhenomenologyEthnographyNarrative analysisGrounded theoryGeneral inductiveDiscourse analysisCase studies

General approachGeneral approachGeneral approachData analysisData analysisData analysisSpecific data presentation

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 4

Qualitative approaches:Disciplinary associations

PhenomenologyEthnographyGrounded theoryGeneral inductiveDiscourse analysisNarrative analysisCase studies

Sociol, Anthro, NursingAnthropologySocial science Soc Sc & healthSociol, PsychologyAnthropologyGeneral

GPs’ experiences of patients’ complaints (UK) - Sample details

Qnn sent to 437 GPs in 3 health areas288 returned questionnaires (66%)96 reported being complained about67 agreed to be interviewedSelected 33 stratified by GP profile30 able to be interviewedJain, A. & Ogden, J. (1999). General practitioners' experiences of patients' complaints: qualitative study. BMJ, 318, 1596-1599.

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GPs’ experiences of patients’ complaints - Interview Qns

"Can you tell me the effects of the patient's complaint on your life?"

(followed by prompts if necessary)“Can you tell me about the role played by others?”“What effect do you think it has had on you?”“Do you think the patient had a right to complain?”“Can you tell me what the patient complained about?”

Jain, A. & Ogden, J. (1999). General practitioners' experiences of patients' complaints: qualitative study. BMJ, 318, 1596-1599.

Stages of research

SamplingNumbersSelection criteriaRecruitment

Data collection techniquesData processing (following collection)Data analysis procedures

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 6

Sampling strategies - 1

Numbers- in exploratory research, keep samples as small as possible - get more information from fewer peopleSelection criteria - select only people with specific characteristics of interest (purposive sampling)

Sampling Strategies - 2

Ensure diversity: Select people whose life circumstances vary within the defined groupData saturation: Finish adding new cases when no new ideas are emergingInitial data analysis with first 2-3 interviews/cases revision of the interview or data collection procedures

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Main types of qualitative data collection techniques

InterviewsEthnography & observationSelf-completion questionnairesOther qualitative methods

case studies, media items, documents

INTERVIEW FORMATS

Individual interviewsGroup interviews

Focus groupsWork groupsWhanau interviewsHousehold interviews

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FOCUS GROUPSKey features

Usually about 5 -10 people who have something in commonFacilitator initiates & guides discussionSpecial arrangements for recording discussionNeeds suitable room (reduce disruptions)Usually 1½ - 2 hours long

FOCUS GROUPS

Advantagesgenerate ideas and elicit topics which are unlikely to arise with individual interviews

♦ can quickly identify a range of issues which are relevant to a research topic

Disadvantages♦ generate large amounts of data♦ need a skilled facilitator to obtain good quality data

and keep participants on topic

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 9

Qualitative MethodsSELF-COMPLETION QUESTIONNAIRES

Surveys on specific topicsUsing both open-ended & structured questionsKnowledge questions following training Self-reports of behaviours and attitudes

Styles of Observation

Ethnographic, open-ended - no prior assumptions, what are types of events in these settings?Semi-structured - focus on specific event & behaviours, recording open-endedStructured - counting specified events within planned time-frame

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Ethnography

Ongoing observation as a participant observer, immersed in daily lifeDescribing & interpreting social events, communication, behaviours and meanings in cultural and social groupsInvolves multiple types of data collection including observations & interviews

Other qualitative data sources

♦ case studies♦ documents, archives & records♦ media items (e.g., newspaper, magazine,

audio)

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Research StrategiesProgrammatic research

Using several small scale studies so each study builds on the findings from previous studyStart data analysis while data gathering is in progressSample for diversity with specified parameters of sample

How trustworthy are qualitative data?

Trustworthiness of qualitative data assessed in somewhat different ways from quantitative dataConsistency checks in data analysisStakeholder checksTriangulation of data sourcesIndependent replication of findings

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Triangulation techniques

Triangulation techniques may involve:two or more data-collection methodstwo or more research frameworks or perspectivestwo or more data sources (using the same method)two or more data analysis techniques

Common styles ofqualitative data analysis

Grounded theoryGeneral inductive approachEthnographyNarrative analysisPhenomenologyDiscourse analysisCase studies

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Approaches to qualitative data analysis

Interpretive Summarising“Post-modern" "Critical realism"Detailed elaboration Coding into categoriesof multiple meanings Large amounts of textSmall amounts text reduced to summaryexplored in detail themes

ExamplesPhenomenology Narrative Grounded theoryDiscourse analysis Case studies Inductive approaches

Grounded theory

To generate or discover theoryInductively from the context of studyDeriving categories from events and instances (open coding)Using theoretical sampling of participantsUntil the categories are saturated

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 14

Quality Nursing Care Report:Example of grounded theory

OverviewNurse-patient relationship was identified as a key component of quality nursing care.Need to incorporate contextual conditions in models of nurse patient relationshipsSource: Williams, A.M. & Irurita, V.F. (1998). Therapeutically conducive relationships between nurses and patients: An important component of quality nursing care. Australian Jnl of Advanced Nursing 16, 36-44.

Quality Nursing Care:Methodology

Sources of data were interviews with 22 nurses and 23 patientsOther sources of data included field observations, hospital documentsGrounded theory methods were used, data analysed by the constant comparative method of analysis

Source: Williams & Irurita, 1998,

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Quality Nursing Care:Establishing therapeutic relationships

Nursing care seen as therapyQuality nursing care had a therapeutic effect on patient wellbeing & recovery Therapeutic relationships established by the initiation of rapport leading to trust.Basic problem for nurses was inability to provide quality nursing care to all patients because of inadequate time

Establishing therapeutically conducive relationships

Initiating rapport

Developing trust

Identifying patients needs

Delivering qualitynursing care

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Quality Nursing Care:Initiating rapport

Rapport established by informal, social communication that enabled nurses and patients to get to know each other as persons:

“… by chatting along as you’re doing things … with the patient. Asking them questions about themselves … And then they will sort of give you a clue and actually then tell you how they are feeling about things. …” (Nurse)

Quality Nursing Care:Identifying patients needs

Quality nursing care was described as “meeting all the needs of the patients …you’re looking after.” (nurse) Nurses became more aware of patients needs by talking to patients and getting to know them as persons. In this way they were better able to address and anticipate their needs.

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Quality Nursing Care Delivering quality nursing care

Patients viewed an effective nurse-patient relationship as contributing to quality care by being treated as a person, not just a patient or object.Nurses came past and would just touch your hand …(it said) you’re a fellow human being … I’m with you …That to me was truly as important as medication.” (patient)

General Inductive ApproachAssumptions

Data analysis determined by both the research objectives (deductive) and multiple readings & interpretations of raw data (inductive)Main task is the development of categories into a summary framework which conveys key themes & processesThe researcher must make decisions about what is important in the data

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General Inductive ApproachProcedures

Preparing textImmersion of researcher in textIdentify and define categoriesSelect text segments into categoriesSearch for sub-topics, inconsistencies and new insightsCombine specific categories into 4-8 major categories

GPs experiences of patients’ complaints - Analysis & findings

Interview transcripts were read several times to identify themes and categoriesParticipants experiences of complaints in catgeorised into three stages: initial impact, conflict, and resolution. Initial impact described being out of control, feelings of shock and panic, & a sense of indignation towards patients ...

3 April, 2002

Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 19

GPs’ experiences of patients’ complaints - Analysis & findings

Conflict stage referred to... feelings of anger, depression, & even suicide, conflicts around professional identity... doubts about clinical competence, conflicts with family & colleagues …Resolution stage .. meant practising defensively, planning to leave general practice or no resolution achieved.

Ethnography

Ongoing observation as a participant observer, immersed in daily lifeDescribing & interpreting social events, communication, behaviours and meanings in cultural and social groupsInvolves multiple types of data collection including observations & interviews

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Injury among children of low-income families (USA): Focused Ethnography

A focused ethnographic study to explore the household context of injury for low-income Hispanic children, including demographic, behavioural, and environmental factorsLooked at behaviours and cultural values that may contribute to injury patterns

Source: Mull, D. S. et al (2001) “Injury in children of low-income Mexican, Mexican American, and non-Hispanic white mothers in the USA: a focused ethnography, Social Science & Medicine, 52, 1081-1091.

Injury among children of low-income families (USA): Focused Ethnography

Semi-structured, open-ended interviews with 110 mothers 50 Mexican (Mexican born)30 Mexican American (American born)30 non-Hispanic white mothers“The inclusion of Mexican American and white mothers … groups from same low-income neighbourhoods… enables us to see how these disadvantages were counterbalanced by other characteristics of the Mexican families”

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Injury among children of low-income families (USA): Focused Ethnography

Observation of environmental conditions in household and neighbourhood

“By going to the homes, we were able to see actual conditions in the households and witness maternal and child behaviours in that setting rather than relying on mothers’ descriptions conveyed out of context … there is often a large gap between what people say and what they do”

Injury among children of low-income families (USA): Focused Ethnography

“For example … we documented the presence of potential poisoning agents in the home and used a checklist to record how all medicines and household chemicals were stored … noted how young children were being supervised and by whom … questioned mothers extensively about what we had observed … to determine the reasons for conditions and behaviours that … might heighten or lessen the likelihood of pediatric injury. “

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Injury among children of low-income families (USA): Focused Ethnography

What emerged is a group of themes derived from close analysis of mothers’ responses Falls were said to be the most common injury, followed by burns and poisoningsFindings were related to sociodemographic, behavioural and environmental data including age, education, employment, income, housing and behavioural factors

Injury among children of low-income families (USA): Focused Ethnography

Mexican mothers Mainly from rural and semi-rural backgrounds, had less experience with typical urban hazards such as multi-storey buildings, staircases, heavy trafficFalls severest … partly because living in more hazardous physical surroundings Lowest family income of all 3 groups, more likely to live in dilapidated and unsafe housing, forced to live in crowded households

“Two of the nine falls were down apartment staircases…infants in old style walkers narrow enough to fit doorways purchased at yard sales to save money”

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 23

Injury among children of low-income families (USA): Focused Ethnography

Mexican mothersFew had adult family members to help care for children, mothers tended to rely on older children to watch the younger ones… Most of the time supervision seemed both appropriate and beneficial to the child … fewer children seemed to be excessively active and/or aggressiveThe higher incidence of hospitalization… would appear to be more related to poverty, lack of education, and environmental hazards than to mental impairment or negligence

Injury among children of low-income families (USA): Focused Ethnography

Mexican American mothersFamily members lived nearby, but often estranged from themFamily cohesiveness was in between that of Mexican and white, many recounted instances in which their parents’ traditional authoritarian attitudes conflicted with US emphasis on children’s individualism and independence, dividing the family and creating stress No Mexican American or white mother reported serious injury that had not been attended to

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Prepared by David R. Thomas, Health Research Methods Advisory Service, University of Auckland 24

Injury among children of low-income families (USA): Focused Ethnography

Non-Hispanic white mothersFamilies exhibited comparatively less cohesion and solidarityMany were impaired by past or current reported drug use… some seemed to blame their children for having caused their own injuriesMuch more likely to be very active and aggressive children, hence difficult to protect from hazardsCompared to the other women described more cases of siblings intentionally or unintentionally causing injury

Injury among children of low-income families (USA): Focused Ethnography

(For the Mexican mothers)…. we found that presenting culturally

appropriate safety videos in a focus group situation was an excellent way to stimulate conversation among mothers since they are comfortable talking among themselves in small groups.

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Discourse analysis

Focus on talk and text as social practicesExamines the range of styles, linguistic resources and rhetorical devices used to construct discourse about actionsFocus on how perspectives are constructed using rhetorical or argumentative styles

Phenomenology

describes meaning of lived experiences for several individuals about a phenom.analysis of specific statements & themes, search for all meaningsThe researcher relies on intuition, imagination & universal structures to obtain a picture of the experience

Creswell, J. W. (1998). Qualitative inquiry and research design. Thousand Oaks, CA: Sage. pp. 51-55

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Phenomenology

an interpretive method where participants interpret their experience and the researcher interprets the dataseeks to uncover the meanings within experience andtranslate felt understandings into wordstries to get as close to the experience, as it happened, as possible

(adapted from summary by Liz Smythe)

Processing qualitative data

Transfer from audio tape or hand written notes to word processorRemoving identifying information, clarify ambiguities, insert context commentsTidy up formatting (spelling, headings)Making backup copies of cleaned filesTransfer to data analysis folder or specialised software

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Developing coding categories

Initial broad categories determined by the objectives of the researchInitial specific categories developed from detailed examination of data and identification of frequent or significant themes, words, phrases or events. Labels are assigned to categories to identify their content & meaning

Trustworthiness checks

Consistency checksGo through data several times to check consistency of coding systemUse of independent coder

Validity checksOpportunities for stakeholders to comment on categories or the interpretations madeComparisons with previous researchUsefulness for policy and services planning

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Summary points - 1Qualitative research strategies

Use of qualitative methods can be a powerful research strategyUnderlying assumptions & procedures often very different from quantitative approaches

Summary points - 2Qualitative research strategies

Qualitative methods often designed, used and reported badlyQualitative methods require considerable experience to be used effectively